DESCRIPTION: There are serious workforce shortage problems in providing clinical mental health services for public sector consumers. In the mental health field, "telepsychiatry" has introduced a reasonably priced means of solving these long-standing workforce problems. This is of special significance for the public sector service system charged with providing healthcare to people living in geographical areas where provider experts are not readily available. A comprehensive review of extant empirical data indicates that psychiatric interviews conducted via telepsychiatry appear to be generally reliable, and that patients and clinicians generally report high levels of satisfaction with mental health services received via telepsychiatry. While this early research is encouraging and clearly demonstrates wide-ranging needs that might be met by using telepsychiatry, it is remarkably silent on whether mental health treatments can be effectively delivered via teleconferencing technology. In particular, it is not known whether specialty mental health treatments for specific disorders (e.g., PTSD, depression, panic disorder, schizophrenia) can be effectively delivered. Thus, the body of literature is strikingly undeveloped in this way. Because telepsychiatry programs are rapidly springing up all over the world (e.g., Australia, the U.S. Department of Defense), research that addresses the effectiveness of this mode of service delivery is desperately needed. Telepsychiatry research is needed that includes prospective, randomized evaluation of clinical outcomes for specific treatments with specific populations, such as individuals with PTSD. Specifically, this applicant aims: To test the hypothesis that a novel mode of mental health service delivery, using videoconferencing technology ("Telepsychiatry"), will be equally effective to a traditional mode of mental health service delivery ("Same-Room") for providing a mental health intervention to veterans who are trauma victims with PTSD. The study proposed in this application will allow a direct comparison of each mode of service delivery provided to veterans through a Veterans Affairs (VA) outpatient PTSD clinic on two categories of outcome variables: 1) clinical outcomes, such as symptom severity and social functioning; and 2) process outcomes, such as patient satisfaction/acceptance, treatment credibility, session attendance, treatment adherence, and treatment dropout.